The Game Change Project

Register

Please fill out the form to register an individual for activities at the Game Change Project.

Registration Form

Referred By:


Organisation:


Please note that the information on this form is for the use of the Game Change Project and is not available to any other individuals or groups. This means that we will not disclose your email address, mobile number or any other details to another individual without your permission.

Details of Young Person

First Name


Surname


Date Of Birth


Address

Line 1:

Line 2:

Town:

County:

Postcode:


Telephone:


Sex / Gender:



Emergency / Parental Contact Details

In the event of an emergency relating to the participant please provide information below which we can use to contact you.

Adult Emergency Contact Name

Relationship

Contact Telephone Number/s

Email Address

Medical Information

Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness etc.) which we should be aware of?


Diet

Please give any details of special dietary needs we should be aware of (e.g. food allergies):


Behaviour

Please give details of any behavioural/emotional needs we should be aware of:


Activities

Please check which modules are of interest and indicate level of experience (if any):

Experience Level:




Experience Level:




Experience Level:





Marketing

We may take photographs and videos of activities. These images may be used for promotional purposes. If you do NOT wish for your son/daughter to be photographed please tick this box:



Consent

I agree to my son/daughter participating in The Game Change Project and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child.

I accept and support the code of conduct for behaviour. I realise and accept that in the event of my child’s behaviour adversely affecting the safety of the activity, the organisers reserve the right to return my child home.







The Game Change Project
The Game Change Project